Category Archives: Recovery from injury

Adventures in aging: Part 3 – Seriously?! There’s more?!

Apparently the universe was not done giving me the “slow down” messages with simply a detached retina and sore knee that can’t be assessed, let alone fixed, until after my retina heals. So, … at least eight weeks.

The night of my surgery, I stumbled in the bathroom twice in succession, heard a loud pop both times in my right knee (the sore one), felt excruciating pain, and to cut to the chase, had to be taken to the hospital in an ambulance. I feel oddly embarrassed by this. I think prior to this week I’ve been in the ER only a handful of times in my life, usually for someone else, but only once before in an ambulance.

The 911 response team was wonderful. They immediately gave me IV pain meds that took the edge off. “They won’t stop the pain”, the paramedic said. “They’ll just make you care less.” The EMTs apologized for the fact that they actually had to get me on the gurney and into the ambulance and to the hospital. And all this was going to hurt… A lot… It did.

Ambulance maintenance clearly does not include shocks. I felt every bump along the way. The EMT gave me a little more pain medication in route.

Apparently fentanyl derivatives make me very talkative. The EMT kept asking me questions and I kept answering them. I babbled the whole way. It only occurred to me later that this was a distraction strategy – keeping my mind on something other than the pain. He asked about my career – directing forensics at St. Olaf College immediately after earning my PhD, helping create the precursors to what become the School of Public Health at UNR, serving as the Kansas Health Foundation Distinguished Chair in Strategic Communication and starting the Wichita State University Hunger Awareness Initiative, teaching judges around the world, traveling with my children, my amazing partner Andrew, and on and on. I don’t think I’ve ever told anyone so much of the story of my life in one 20 minute moment. And through it all, I reaffirmed for myself how wonderful my life is except for this weird moment… and, you know, some other weird moments,… but those are different stories. Apparently even when I’m on drugs I recognize how privileged and blessed I am.

We picked the hospital we did because it was in my insurance network and I’d had a very positive experience there earlier in the week when my retina partially detached (see parts 1&2 in this series). Andrew also called in advance to make sure they had people available to address my injuries. They told us they had people on call who could take care of me, if necessary.

We and the hospital staff differed vastly in our understandings of what “care” meant. For us that meant figure out what’s going on with my knee and get a plan to fix it. For them it meant “If it ain’t broke we don’t fix it”, a literal quotation from my attending physician. They did, however give me great IV pain meds, so I was able to relax a bit.

Andrew followed the ambulance in his car. At the hospital the ambulance went in one entrance and the EMTs directed Andrew to park in a nearby lot. “They’ll let you in back as soon as you get in. Don’t worry we’ll take good care of her.” And they did. ⭐️⭐️⭐️⭐️⭐️ to the 911 response team. The ER staff were a mixed bag. I asked for Andrew from the time I got into a bed in the ER. They made him wait an hour and a half in the waiting room until they allowed him back with me.

When we got to the hospital Andrew called my daughter Alyssa. I hadn’t been able to reach her. Alyssa came immediately and they let her back with me.

They did a really nifty set of x-rays in the bed. I didn’t have to move my sore knee much or turn my head. It was pretty snappy. I knew that I hadn’t broken anything. I hadn’t actually fallen. So it had to be soft tissue damage. But x-rays are the ER go to.

What I should have remembered from Alyssa’s experience shredding her knee was that emergency rooms, although they tell you they have orthopedic specialists and surgeons on call, don’t call them to the ER except to set bones. When I say I should have remembered that ERs don’t treat soft tissue injuries, what I mean is that 10 years ago when Alyssa destroyed her knee, severing her ACL, MCL, tore meniscus, and severely bruised her knee, they sent her home with no wrap, no brace, and no crutches because her leg wasn’t broken. When we went to the doctor the next day and found out the extent of her injuries, I was livid. I assumed Alyssa’s experience was just bad care. I didn’t realize it was ER practice not to do anything with soft tissue injuries.

With Alyssa’s insistence, they did finally decide to give me pain meds, the sling that I wear from my thigh to my ankle, and a pair of crutches. They then wished me the best of luck in finding a referral as they didn’t have one to give me. Not sure how any of that means orthopedic surgeons on call… or care… But there you go…

Reflections:

1. I’m really not sure what I should have done when I hurt myself that badly at night. The pain was unbearable. I definitely needed some serious pain meds and I am not clear what the alternative to the ER might have been.

2. I need a clear understanding of what services are provided in the ER. Maybe we all do. It’s important to know that they don’t deal with soft tissue injuries, no matter how painful they are. In the words of my attending physician “We treat blood and bones.” Neither were my issue. In the ER, they x-ray. Because the same ER had done CT scans with and without contrast and ultrasounds earlier in the week, I expected more.

3. It’s very important to have an advocate. My daughter made things happen quickly once she arrived.

4. In all situations, assertiveness and perseverance are important in getting your needs met. It was very difficult to get the health providers to come down to my level so I could actually see them. Since having had my retina reattachment surgery earlier that day I could not lift my head nor could I lie anywhere but on my right side, eyes parallel to the floor. I repeatedly asked the same doctor and nurse to sit down so I could see them when they talked to me. That actually helped them stop treating me like I wasn’t really a person and facilitated communication. I’m glad I was assertive about that.

5. It helps to have a professional that you can call for back up support. I am incredibly grateful to one of my ex students who is a well respected doctor and has worked in the Las Vegas medical community. She talked with me on the phone while I was in the ER, clarified my expectations, and helped me strategize.

6. Even though I didn’t get what I hoped for, a diagnosis and a plan for treatment for my knee, I did get what I actually needed in that moment. I got pain medication, a brace, and crutches. That’s a lot to be thankful for.

On Fear, Hope, a Bracelet, and Gratitude

Sometimes those who love us see more clearly what we need than we do. Today I write about one of those times. Today I write about fear, hope, and a bracelet that signified both. Today I write about gratitude. This month is the 10-year anniversary of the freak dancing accident that resulted in breaking both of my wrists, triple fracturing my right and double fracturing my left. That accident was in many ways both a blessing and a curse. I learned so much about myself and those I love. I learned that people would be there for me if I needed them. I learned I was safe to be helpless. I learned how to deal with the most excruciating pain I could imagine. I learned to slow down, to be kind to myself, to accept care, to ask for help. I didn’t learn these lessons easily, but I learned them.

Throughout the holiday season, I was working my way through splints, then casts, then braces with increasing levels of physical therapy. For homework, I was playing in a bowl of rice multiple times a day to reduce skin sensitivity and promote flexibility. I was opening and closing wooden clothespins, learning to touch my fingertips to my thumbs, and trying to relearn how to do simple tasks for myself, like feeding myself, brushing my teeth, dressing myself.  

One day, my friend Miche Dreiling brought me a present. It was a small, square box. Inside was a delicate, red bracelet. It was the most terrifying thing I had ever seen. A bracelet! A bracelet? My skin was so sensitive I couldn’t imagine ever being able to wear a bracelet again. Even though this one was so delicate and small, it looked like a torture device to me. I know I looked at Miche confused. “Not for now”, she said. “For later… when you’re healed”. I closed the lid on the box and put the bracelet in a drawer in my hutch. I wondered if I would ever take it out. It became a symbol of fear and hope.

The day I decided I was ready to try to wear it finally came. I was apprehensive as my skin was still so sensitive, but it was time. Andrew helped me put it on. And though I could only wear it for a short time that day, I knew that sometime soon, I would be able to wear it for much longer periods. I knew that I would someday be able to wear all my treasured bracelets and rings whenever and for as long as I wished. That day wasn’t here yet, but it was coming. Today as I reflect 10 years later, I am wearing an iWatch, a wrap bracelet, and 5 rings on my hands. The moment I opened Miche’s gift, I doubted that this day would ever come. Now I don’t think about jewelry anymore. I wear it easily and without pain.  

In all honesty, what at first felt like the most insensitive gift I could imagine became a talisman of hope as I embraced my healing and the belief that I would regain full function and capacity. I am grateful that Miche brought me this talisman of hope. I doubted the wisdom of this gift. In retrospect, it was just the gift I needed. I cherish that bracelet as a reminder that in fear, there can also be hope.

Sidelined by Broken Wrists – Part 4 OR Why I <3 Dr. Jason Mettling, DPT

Some context: After the dancing accident, when it was clear I was hurt, my friends took me to an emergency room in Tacoma, Washington. When the x-rays came back, I learned that I had a triple fracture in my right wrist and a double fracture in my left. Miraculously, the fractures in both wrists were clean and there was no bone displacement. The physician in the ER put my arms, from elbow to finger tips, in cloth wrapped, plaster-based splints that went up the underside of each arm to the center of my palm. I curled my fingers forward over the lip of the plaster and once it hardened, the doctor wrapped gauze, then elastic wraps around my arms to my fingertips. He then put me in slings that crossed my arms over my chest, hands facing upward, and held them in place. The goal was to keep anything from moving until I could be assessed by an orthopedic surgeon. The ER doc said he hoped that nothing would move and that I would be able to avoid surgery and metal plates in my wrists.

When I got home to Wichita, my family physician took more x-rays thinking he’d just put me in casts. When he saw the extent of the damage and the fact that everything was still in place, he sent me to an orthopedic surgeon. My ortho doctor took more x-rays and as nothing had moved, decided to leave the splints on for several more weeks so that my wrists could start to heal. He said that if nothing moved in several weeks, we might move on to casting. If anything moved or was misaligned, he said, I would need surgery. After several more weeks, nothing had moved and my ortho doctor decided to keep me in splints a bit longer. He did think it was time to get my fingers moving again, so he cut the splints and the wraps to the base of my fingers so that I could move them. My fingers had been structurally paralyzed since my fall and it felt like there were fiery needles running through them when I tried to move them. The pain was excruciating.

That afternoon, I met my partner in healing, my physical therapist, Dr. Jason Mettling, DPT. To say that Jason played a pivotal role in my healing and recovery would be an understatement. He was critical to my mindset as I slowly regained capacity. He was kind, compassionate, always encouraging, always pushing (literally!!! and figuratively). He was funny; he was supportive. He was exactly the kind of engaging, involved partner I needed in physical therapy. Our personalities, our goals, my fears, my independence, my need for support, his firm direction, his clarity of purpose, his willingness to listen, to explain, and to explore, made us a perfect partnership for this stage of my healing adventure.

I was apprehensive about physical therapy. I was afraid of the pain and I was terrified that I would not be able to get full function back in my hands. Dr. Mettling built my trust from the beginning. I assumed that when the splints were cut I would be back to normal. I was wrong. I could barely move my fingers. I couldn’t touch my fingertips to my thumb. I couldn’t curl my fingers or make a fist. I had to learn to use my fingers, and later my hands, wrists, and arms all over again. This was going to be an uphill battle. When I first met Jason, he asked me if I trusted him. I replied, “I don’t know you.” He looked me straight in the eye and said “I can get you back where you were, but you have to trust me. It’s going to hurt, sometimes a lot, but there is a reason for everything we do.” His words helped counter my fear and gave me hope for a full recovery.

During our time working together, there were many ups and downs. My level of pain surprised both of us at some points. During one session I almost passed out due to the intensity of the pain. We strategized when I would take pain medication so that I would be able to work hard and endure during each session. As I reflect on Jason’s approach, I see him as a gentle torturer. He pushed me for the progress he wanted, both literally, as he applied pressure on my wrists to help increase my flexibility, and figuratively, encouraging me to do my homework.

During this process, I developed a serious dislike for wooden clothespins. Once I could get my fingertips near one another again, my next task was to regain finger flexibility and strength. My least favorite exercise involved holding a wooden clothespin between my thumb and a finger and opening and closing it. To begin with, I couldn’t open them at all. Later, I could open them a bit. Today, I can open and close a clothespin multiple times with each finger / thumb combination on both hands. I enjoyed playing in 3 pounds of raw rice more. This exercise had two main purposes. One was to get me used to resistance and to build flexibility. The second, in some ways more important purpose, was to reduce the hypersensitivity my hands and skin had developed after the accident. Any touch was painful. At first I had to put the rice in warm water and swish gently. As I overcame a bit of the sensitivity, I could play in the dry rice, moving my fingers through it, making fists around it, burying my hands in it.  I loved the tactile nature of this exercise and the progress I could see myself making.

One of the things Jason did especially well was see the advances I made and celebrate my progress. He was always encouraging. At times, this was what kept me going. I’ll never forget how hopeless I felt when I went to see my orthopedic surgeon (how telling is it that I can’t remember his name, but Jason’s comes easily to mind) and he wanted me to put my arms straight down in front of me, backs of my hands together, and then raise my arms along my body until my lower arms were parallel to the floor, all the while keeping the backs of my hands together. When he demonstrated it, I thought, “I don’t think anyone can do that! How did he DO that?” To do that, you need to bend at the wrists and elbows and keep your shoulders down. It is hard! Really! Try it! I couldn’t do it. I was only a little better at the next behavior he demonstrated. He wanted me to put my palms together in front of my face, fingertips up, and lower my arms along my body, again bending my wrists and elbows until my hands were in the Namaste position and my lower arms were parallel to the floor. While I could at least understand how this movement was possible, I couldn’t get anywhere near it. I can now do the latter one. I’m still not even close on the former. I challenge you to try both to see what I mean about how hard they are. I went home from that appointment depressed. I wasn’t making progress. I was FAR from making progress. I should be able to DO these things.

The next morning I had PT with Jason. I was still bummed when I arrived. “What did the doctor say”, he asked. I paused, “Basically, he wants me to be able to do things I’m nowhere near being able to do and I’m really frustrated”, I replied. “I thought I was doing so well.” Jason reminded me that I had been incapacitated through splints, casts, and was only now beginning to get out of my braces for short periods of time, that this would take time. He reassured me that I was doing great and that I would get there. The most important thing he told me was to remember that with the kind of injury I had, incapacitating me was the best option. We avoided surgery that way, which often leads to less satisfactory long-term outcomes. And while my short-term outcomes were more painful and more frustrating, in the long run, I would be better off. He said he understood my frustration, but that I needed to remember that my muscles had been unable to move through the splint and cast phases and that I was rebuilding my muscles and retraining my nerves. I just needed to be patient. Patience had never been one of my strong suits. I’m a “get ‘er done” kind of person. Breaking my wrists changed that, slowly, but surely.

Several times during my therapy, I hit a plateau. When this happened, it was frustrating and fear inducing. Was this the best I was going to be able to do? Had I reached my limit? During one particularly frustrating plateau, Jason came up with the idea of having me come in 15 minutes early for my appointments and put moist heat in the form of large pads around my wrists to help them loosen up and get ready for our work. That helped me get beyond that plateau.

When Jason told me we were coming to the end of my need for PT, I was scared. We had come so far, but I felt I had so far yet to go to get “back to normal”. I learned through this adventure that there are three stages in recovering from a temporary, incapacitating injury. The first and second stages overlap a bit. The first stage is simple healing. For me, this lasted 3 months as my wrists were first in slings, then in casts, then in braces. The second stage began when my orthopedic surgeon cut the tops off my slings so I could learn to move my fingers again. The pain of reactivating muscles and nerves, dormant for months, was almost worse than the pain of breaking my wrists in the first place. Then I got casts, which allowed me to do more finger work. After the casts finally came off, I went into braces which I could remove for physical therapy and to do my “homework” and which allowed me to learn to use and rebuild strength in my wrists and arms again.  I wasn’t prepared for the pain involved in this second stage or how slow the process of healing and regaining capacity would be.

When PT ended, I was ready for the third stage in recovery, refining skills and building strength over time. Slowly, I regained more and more capacity. I remember the first time I brushed my teeth. It felt amazing! I remember the first time I fed myself. My son took me out to a restaurant and I got a BLT which he cut into pieces so I could pick them up and feed myself. I remember the first time I put mascara on. I remember the first time I cut up vegetables to make a soup. Each first was hard. Many of them hurt. But, one by one, I learned to do things for myself again! The last three milestones were successfully brushing my long hair and pulling it back in a band, scrubbing my back in the shower, and hooking my bra. Life’s simple pleasures. I still might need help with a particularly difficult lid once in a while. Squishy water bottles are the worst. While I still fear hot yoga (particularly sun salutations – the downward dog to plank to chaturanga, back to downward dog part gives me heart palpitations), overall, today, little more than 2 years after I fell, I can do anything I desire. Maybe after my Florence adventures, I’ll head back to hot yoga. I thank Dr. Jason Mettling for being my inspiration, my cheerleader, my taskmaster through physical therapy. I thank him for being such an important partner in my healing adventure!